title: Contrast-enhanced MR mammography: improved lesion detection and differentiation with gadobenate dimeglumine.
abstract: OBJECTIVE
  The objective of our study was to intraindividually compare 0.1 mmol/kg doses of gadobenate dimeglumine and gadopentetate dimeglumine for contrast-enhanced breast MRI.
  
  
  METHODS
  Forty-seven women (mean age +/- SD, 50.8 +/- 12.9 years) with breast lesions classified as BI-RADS category 3, 4, or 5 for suspicion of malignancy underwent two identical MR examinations at 1.5 T separated by 48-72 hours. T1-weighted gradient-echo images were acquired before contrast administration and at 2-minute intervals after the randomized injection of gadopentetate dimeglumine or gadobenate dimeglumine at 2 mL/s. Two blinded readers evaluated randomized image sets for lesion detection and differentiation as benign or malignant compared with histology. The McNemar exact test and the generalized estimating equation (GEE) were used to compare lesion detection rates and diagnostic performance in terms of sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).
  
  
  RESULTS
  Histopathology data were available for 78 lesions. Significantly more lesions overall (75/78 [96%] vs 62/78 [79%], respectively; p = 0.0002) and significantly more malignant lesions (49/50 [98%] vs 38/50 [76%]; p = 0.0009) were detected with gadobenate dimeglumine than gadopentetate dimeglumine. All detected malignant lesions were correctly diagnosed with both agents. More detected benign lesions were correctly diagnosed with gadobenate dimeglumine than with gadopentetate dimeglumine (20/26 [77%] vs 17/24 [71%], respectively). Differentiation of lesions was significantly (p = 0.0001) better with gadobenate dimeglumine. Significantly better diagnostic performance was noted with gadobenate dimeglumine than with gadopentetate dimeglumine, respectively, for sensitivity (98.0% vs 76.0%; p = 0.0064), accuracy (88.5% vs 69.2%; p = 0.0004), PPV (86.0% vs 76.0%; p = 0.0321), and NPV (95.2% vs 57.1%; p = 0.0003).
  
  
  CONCLUSIONS
  Lesion detection and malignant-benign differentiation is significantly better with 0.1 mmol/kg gadobenate dimeglumine than 0.1 mmol/kg gadopentetate dimeglumine.
authors.affiliation: Department of Radiological Sciences, University of Rome La Sapienza, Viale le Regina Elena 324, 00161 Rome, Italy. federica.pediconi@uniroma1.it
authors.forename: Federica
authors.initials: F
authors.lastname: Pediconi
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Simona
authors.initials: S
authors.lastname: Padula
authors.forename: Antonella
authors.initials: A
authors.lastname: Roselli
authors.forename: Valeria
authors.initials: V
authors.lastname: Dominelli
authors.forename: Sabrina
authors.initials: S
authors.lastname: Cagioli
authors.forename: Miles A
authors.initials: MA
authors.lastname: Kirchin
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Pirovano
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003287:Contrast Media; D018592:Cross-Over Studies; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008327:Mammography / Q000379:methods; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D009942:Organometallic Compounds; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine; D019786:Gadolinium DTPA